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Why are hospitals penalized for readmissions?

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U.S. hospitals penalized
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  • Medicare’s Hospital Readmissions Reduction Program (HRRP) requires CMS to penalize acute care hospitals for readmissions within 30 days of discharge for these admission types:
     

    • Acute myocardial infarction (AMI)
    • Heart failure (HF)
    • Pneumonia (PN)
    • Chronic obstructive pulmonary disease (COPD)
    • Elective total hip arthroplasty (THA)
    • Total knee arthroplasty (TKA)
    • Coronary artery bypass graft (CABG) surgery

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Large, safety-net hospitals, academic medical centers and non-profit hospitals are often on the penalty list.

  • Large hospitals
  • Teaching hospitals
  • Non-profit hospitals

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Readmissions of patients with mental health or substance abuse concerns
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Mental health or substance abuse = Significantly higher potential for readmissions


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Top 3 initial admissions leading to preventable readmissions

How can we help you?

3M can help you identify root causes, adjust for risk, enhance documentation and coding to eliminate data noise and get down to seriously cutting your readmission rates.
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  • Notes: 1 Readmission numbers and penalty information provided by CMS: https://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/AcuteInpatientPPS/Downloads/FY2018-CMS-1677-FR-Table-15.zip 2 Hospital profile data were derived from the American Hospital Association’s AHADataviewer and then matched with the CMS penalty data referenced above. 3 See section 3.9 of “Potentially Preventable Readmissions in Rhode Island” study (April 28, 2014): http://www.ohic.ri.gov/documents/RI-Potentially-Preventable-Readmissions-2014-04-28.pdf 4 Florida Medicaid Management Information System (FMMIS) Eligibility, Encounter, and Claims Information, August 2014 - July 2015, page 21: http://ahca.myflorida.com/Medicaid/Finance/data_analytics/BI/docs/Quarterly_ SMMC_Report_Spring_2017.pdf
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